BACKGROUND To describe short and long-term survival of patients with descending thoracic aortic aneurysms (TAA) following open and endovascular repair (TEVAR). METHODS AND RESULTS Using Medicare claims from 1998–2007, we analyzed patients who underwent repair of intact and ruptured TAA, identified using a combination of procedural and diagnostic ICD-9 codes. Our main outcome measure was mortality, defined as peri-operative mortality (death occurring before hospital discharge or within 30 days), and five year survival, using life-table analysis. We examined outcomes across repair type (open repair. or TEVAR) in crude, adjusted (age, sex, race, procedure year, and Charlson comorbidity score), and propensity-matched cohorts. Overall, we studied 12,573 Medicare patients who underwent open repair, and 2,732 patients who underwent TEVAR. Peri-operative mortality was lower in patients undergoing TEVAR as compared to open repair for both intact (6.1% versus 7.1%, p=0.07) and ruptured TAA (28% versus 46%, p<0.0001). However, patients with intact TAA selected for TEVAR had significantly worse survival than open patients at one year (87% open, 82% TEVAR, p=0.001) and five years (72% open, 62% TEVAR, p= 0.001). Further, in adjusted and propensity-matched cohorts, patients selected for TEVAR had worse 5-year survival than patients selected for open repair. CONCLUSIONS While peri-operative mortality is lower with TEVAR, Medicare patients selected for TEVAR have worse long-term survival than patients selected for open repair. The results of this observational study suggest that higher risk patients are being offered TEVAR, and that some do not benefit based on long-term survival. Future work is needed to identify TEVAR candidates unlikely to benefit from repair.

No abstract

Operative mortality was halved with SG, with similar late survival for both cohorts. Reinterventions were required at a nearly identical rate for open repair and SG, and both groups experienced similar rates of spinal cord ischemic complications.